Assessment of Health Literacy in Self-Reported Spanish-English

Bilinguals

Amarilis Acevedo, Ph.D.

Associate Professor, Center Psychological StudiesNova Southeastern University, Fort Lauderdale, FL

Introductory Comments

• Terms “Hispanic,” “Latino,” & “Individual of Latino Background” interchangeably

• Highly heterogeneous group, from over 20 different countries of reference, generational history, etc.

• Socio-demographic variables of Hispanics in the U.S. may not reflect those of the population in their countries of reference.

Hispanics in the U.S.

• 317 million: Total population of U.S.

• Latinos constitute 17% of the U.S. total population (i.e., ≈54 million)

• Latinos: Largest ethnic/racial group in the U.S.

Source: Profile America Facts for Features, U.S. Census Bureau News, CB14-FF.22 (2014)]

Hispanics in the U.S. & Language

• After English, Spanish is the 2nd most spokenlanguage in the U.S.

• ≈38 million people in the U.S. speak Spanish at home (i.e., 13% of residents ≥5 yrs of age).

• ≈ 36% of the U.S. Hispanic population is foreign-born.

• Among Spanish-speaking persons in the U.S., more than 13 million speak English “not well” or “not at all.”

Source: Profile America Facts for Features, U.S. Census Bureau News, CB14-FF.22 (2014)

Hispanics in the US & Health Literacy

• Hispanics have the lowest average levels of HL among all racial/ethnic groups in the US, with 41% scoring in the below basic health literacy category, compared with only 9% of non-Hispanic whites.

• Among Hispanics, those who spoke only Spanish before starting school had the lowest average health literacy.

• Hispanics are less likely than other groups to participate in health screenings, and have more difficulty gaining access to health care, contributing to health disparities.

• Various factors contribute to Latino’s low health health literacy including low socio-economic status, limited English proficiency, and cultural barriers.

Source: National Assessment of Adult Literacy (2003)

Some Factors Associated withLow HL

Individual’s Charateristics

• Lower than high schooleducational attainment

• Low SES

• Low reading literacy (NAAL)

• Limited English Proficiency(LEP)

• Age: Older Adult?

Contextual Demands*

• Navigating current healthenvironment

• Many “literacies” needed (e.g., computer, financial)

• Characteristics of medicalenvironment

• Patient-clinican languageconcordance

• Demands to quickly absorbinformation, understandmedical terms and tests, medication regimen, etc.

*Paasche-Orlow et al. (2006); Sudore et al. (2009)

Limited English Proficiency (LEP)

• Spanish speakers with LEP are less likely toundertand prescription labels and have lower HL than their English-speaking peers.

• A person with LEP is unable to obtain, process, and understand health-related information in English and to use the information to prevent diseases or takecare of their own health and those around them.

• The combination of low HL + LEP places additionalburden on the individual beyond either one alone.

Sources: Leyva et al. (2005); Sentell & Braun (2012)

Self-Reported Bilingualism

& Assessment of HL

Participants in Bilingual Study

• Sample: 29* self-declared English-Spanish bilinguals who reported that they speak, read, and/or think in both English and Spanish.

• Psychometric assessment of oral comprehension & reading fluency in both English & Spanish was performed at T1 (n=14) or T2 (n=15)

• T1 to T2 Interval: 0y+8m – 1y+6m

• Place of birth (n = 13 countries)

*Target sample = 42 participants; 13 were lost to follow-up

T1 & T2: Health Literacy, Cognitive Assessment & Other Procedures

T1: Completed TOFHLA-Spanish, SAHLSA, FLIGHT/VIDAS-Spanish, & Cognitive Battery-Spanish

T2: Completed TOFHLA-English, REALM, FLIGHT/VIDAS-English; Marin Acculturation Scale; & provided information about their perceived proficiency in both English and Spanish in four domains (i.e., speaking, understanding, reading, & writing)

Characteristics of Bilingual SampleVariable Mean (SD)

Age (T1) 43.00 (12.8)

Education (yrs) 13.31 (2.4)

Gender (% Female) 69% F

MAS: LanguageMedia

Ethnic-SocialTotal

12.38 (1.8) [Low: ≤ 14]10.41 (2.6) [Mod: 9-11]11.38 (2.4) [Low-Mod (≤11); (12-15)] 34.17 (3.9)

Yrs Residing in US 19.55 (12.2)

Age Moved to US 23.45 (12.4)

% Life in US 0.44 (0.2)

MAS: Marin Acculturation Scale

Bilingual Sample (n=29) Country Where Born & Raised

Country Number Born Number Raised

Colombia 5 5

Peru 5 5

U.S. 5 2

Puerto Rico 3 5

Mexico 2 2

Venezuela 2 3

Argentina 1 1

Dominican Republic 1 1

El Salvador 1 1

Guatemala 1 2

Panama 1 1

Nicaragua 1 0

Honduras 1 1

Bilinguals Tested in Spanish & English: Paired Sample Statistics

SpanishMean (SD)

EnglishMean (SD)

Correlation p

FV HL Scale 26.64 (5.1) 25.96 (5.8) 0.81 <0.001

FV Numeracy Scale 14.54 (4.8) 13.57 (5.0) 0.76 <0.001

FV Fact-Conceptual 7.68 (2.1) 8.07 (2.3) 0.75 <0.001

FV Listening Comp. 9.2 (1.0) 9.1 (2.6) 0.28 0.15

TOFHLA Reading 46.79 (2.8) 42.00 (8.8) 0.76 <0.001

TOFHLA Numeracy 15.14 (1.3) 14.52 (2.0) 0.07 0.72

REALM N/A 54.10 (8.5) N/A N/A

SAHLSA 46.28 (2.4) N/A N/A N/A

Assessment of Bilingualism & Language Dominance

Ability WJ III: Tests of Achievement

Batería III WM: Pruebas de Aprovechamiento

Reading Test 2: Reading Fluency

Prueba 2: Fluidezen la Lectura

Oral Comprehension

Test 15: OralComprehension

Prueba 15: Comprensión Oral

WJ III: Woodcock-Johnson IIIBatería III WM: Batería III Woodcock-Muñoz